Our Services

SERVICES

GYNECOLOGY

OBSTETRICS

INFERTILITY

MENOPAUSE

GYNECOLOGY

An annual exam is an integral part of preventive healthcare. We believe that health maintenance and preventive care is an important part of your overall health; from contraception to hormone changes to cancer detection and prevention. We appreciate you entrusting your healthcare to us! Our goal is to reduce the anxiety often associated with annual exams. We train each of our employees to serve you with compassion, the utmost rigor in the standards of care, the latest technology, and the gentlest protocols.

OBSTETRICS & PREGNANCY

PREGNANCY

We offer comprehensive obstetric services, including care for complicated “High-risk” obstetrics. We value each of our patients as individuals and seek to meet your unique goals in pregnancy, labor and delivery. Our intimate office has dedicated staff and your dedicated physician will see you for all your designated appointments.You are more than a chart. We pride our office in a philosophy of no unnecessary treatment; you are an active participant in the decisions surrounding your healthy baby.

High Risk Obstetrics

Amniocentesis

Gestational Diabetes

Hypertension Pregnancy

Incompetent Cervix

Premature Labor

Twin Pregnancy

Ultrasound

In the field of obstetrics, an ultrasound(a.k.a. sonogram) is the use of high-frequency sound waves to visualize the fetus, placenta and other pelvic structures on a monitor screen. The patient can also view these images during the examination.

The results are very helpful in determining the health of the pregnancy, mother, and baby. Some of the information that can be gathered during an ultrasound are the age of the fetus, rate of growth, fetal position, number of fetuses, and detection of some birth defects. Depending on the progress of the pregnancy, the baby's sex can be determined.

Please discuss scheduling this procedure with your practitioner.

In the area of gynecology, ultrasounds can be useful in examining pelvic organs and the breasts.

VAGINAL BIRTH

Vaginal birth is the natural delivery of the baby through the birth canal and vagina. It usually begins when the mother has labored until the cervix has dilated 10 centimeters.

During the labor process, women may experience stress, discomfort, and even pain. Depending on the birthing plan agreed upon by the woman and her practitioner, medication or other treatment may be applied to ease the situation.

Vaginal Birth After Cesarean Delivery (VBAC)

Vaginal Birth After Cesarean Delivery (VBAC) is the vaginal birth of a baby after a woman has already had a cesarean delivery of a previous baby. There are several advantages in attempting a VBAC: no abdominal surgery and faster recovery resulting in shorter hospital stays.

Several factors( small pelvis, baby's health ) will determine whether a VBAC is a good choice for you. Please consult with your physician to discuss these factors and the best delivery solution for your baby.

Gestational Diabetes

Gestational diabetes is a form of diabetes that occurs during pregnancy.

ScreeningBetween 26 and 28 weeks of pregnancy, all patients are asked to take a screening test for gestational diabetes. This is because gestational diabetes may be harmful to the baby, but otherwise undetectable, and without symptoms. This test involves checking your blood glucose (sugar) level exactly one hour after drinking a measured amount of glucose that we supply on the visit PRIOR to the actual test.

PreparationThe night before your appointment, please eat a good meal, which should include protein (meat, fish, or poultry, for example), starches, fruit or vegetables, and dessert.

On the day of your appointment, eat regular meals before coming to the office. Please have NOTHING BY MOUTH EXCEPT WATER for 4 hours before you drink glucose, and while waiting to have the blood test drawn.Please drink the glucose 30 MINUTES before your appointment time, and drink it in 5 minutes or less. You will be drinking THE ENTIRE 10-ounce bottle given to you, unless instructed differently.

Please note the time that you began drinking so that we know when to draw the blood. Be sure to tell the receptionist upon arrival that your glucose test is being done, so we'll know to draw the blood at the right time. If it gets to be one hour after you drank the glucose, and you've not had blood taken, please remind us that blood is due to be drawn.

Most pregnant women pass this screening test, and, if so, no further testing for diabetes need be done. People who do not pass will need to take a second, more extensive test.

INFERTILITY

INFERTILITY

Partnering with the right physician can help alleviate the burden associated with infertility. We are ruthless in finding the cause of one of the many factors that may be delaying your pregnancy.

Insurance should not contribute to this challenge- we work tirelessly to consult with them after pinpointing an individualized diagnostic plan. Our expert focus on accurately outlining the causes of your infertility helps you get pregnant while avoiding unnecessary or expensive treatments. After diagnosing what may be delaying or preventing your pregnancy, the one or many of the following treatments may be a good fit:

Ovulation Induction

Hysterosalpingogram (HSG)

Male Infertility Treatments

Fertility Preservation

Intra-Uterine Insemination (IUI)

Assisted reproductive technologies (ART), such as in vitro fertilization (IVF)

Intracytoplasmic sperm injection (ICSI)

Preimplantation genetic diagnosis (PGD)

Frozen Embryo Transfer (FET)

Egg Donation

MENOPAUSE

Change isn't always comfortable but it can be mastered. Our reputation for managing this natural phase of women's health is something our providers are well-known for here in South Florida. We offer preventative health, hormone expertise (including bio-identical options), careful screenings, ultrasounds, vaccinations, diagnoses, and aesthetic services for this population. We also provide you with expertise in bone health, breast care, incontinence, libido changes, weight and nutrition management, and depression management.

FREQUENTLY ASKED QUESTIONS

How do I get a prescription refill? Most prescription refills can be completed at the time of your visit. If you need to refill a prescription between office visits, please call our office and allow 24-48 hours for us to submit the information to your pharmacy.

Please allow 3-5 business days for disability insurance forms to be completed.

Do I need a referral?Many insurance companies require you to obtain a referral from your primary care doctor before seeing a specialist. Please check with your insurance company to see if you need one. If you need a referral, and it is not on file when you check in, we will ask you to sign a financial waiver as a guarantee of payment.

What are your billing policies? We understand that the cost of medical care can be unexpected. We will do our best to work with you to make payments as reasonable as possible. We will answer all your questions and make sure that you understand everything about your bill.

Gynecology Questions

Q: Do I need to reschedule my pap smear if I have my period?A: We use the ThinPrep liquid-based pap. You can have a pap smear if you have your period as long as the flow is not very heavy.

Q: How do I know if I have a yeast infection?A: It is normal to have vaginal discharge and it is normal for it vary throughout the month. Your discharge may be abnormal if it heavier than normal and is associated with persistent itching, burning or a foul odor. If you have these symptoms, please call for an appointment.

Q: What is a Colposcopy?A: A Colposcopy is a diagnostic tool to determine the cause of abnormalities found in Pap smears. A colposcopy is a visual examination of the cervix, a relatively simple and painless procedure, usually performed in our office. The actual procedure lasts approximately ten to fifteen minutes.

Q: When do I need to start getting mammograms?A: Women age 40 and older should have mammograms every 1 to 2 years. Women an increased risk of breast cancer should talk with their doctor about whether to have mammograms before age 40.

Post Partum Instructions

Please call our office to make an appointment for your 6 week postpartum visit. If you had a c-section, you will need a 2 week postpartum visit as well.

MEDICATIONS:You may take Ibuprofen which is also known as Motrin or Advil. You may take 600 mg every 6 hours (or 800 mg every 8 hours) as needed for discomfort. Ibuprofen is preferable to Percocet because it does not cause sleepiness or constipation and it is non-addictive. Do not take Ibuprofen on an empty stomach. If you need additional pain relief, continue taking Ibuprofen, and add Percocet or Vicodin. You may take 1-2 Percocet or 1-2 Vicodin by mouth every 3-4 hours as needed for moderate to severe pain. Do not take on an empty stomach. These are narcotic medications that may cause sedation and constipation. Both medications are safe while breastfeeding.

Be sure you are actively preventing constipation- Drink at least 64 ounces of fluids per day and eat a diet rich in fiber (whole grains, fruits and vegetables). Colace, Metamucil, and Milk of Magnesia can also be used to prevent or treat constipation; they are over the counter, safe to use while breastfeeding, safe to use together, and can be taken as directed on their bottles. Prenatal Vitamins/Iron Supplements/Birth Control- If you are not breastfeeding, continue taking your prenatal vitamin for 6 weeks. If you are breastfeeding, keep taking your prenatal vitamin for as long as you are breastfeeding.

If you were taking Iron supplements during your pregnancy, continue until your 6 week postpartum visit. If you have postpartum anemia, your doctor will recommend starting Iron supplements. You may take Iron Sulfate (also known as Ferrous Sulfate) 325 mg 1-2 times per day for 6 weeks. Alternatively, you may take Elemental Iron 60 mg once daily for 6 weeks. Both are available over the counter. Birth control options will be discussed at your postpartum visit.

EMOTIONAL CHANGES:You may feel tired, anxious or sad and you may notice you cry very easily. This is normal and is called “postpartum blues” or “the baby blues”. These feelings can begin a few days after delivery and usually disappear in about a week or two. Prolonged sadness may indicate Postpartum Depression. Please call the office to speak with us if you are experiencing prolonged or severe sadness.

BREASTFEEDING:Breastfeeding is recommended and encouraged. Littleton Adventist Hospital has lactation consultants available to help with questions. If breastfeeding is not chosen, or discontinued, we recommend using an iron-fortified formula.

SORE NIPPLES:May be relieved by ice packs and regular feeding from both breasts. Avoid prolonged feeding sessions and ensure a good latch. Keep your nipples as dry as possible between feedings. Be sure to wear a good support bra and allow the nipples to air dry after feeding. Apply ointment (such as Motherlove’s Nipple Cream, bagbalm, cool tea bags, Vaseline and A&D) to any cracks.

BLOCKED DUCTS:Are usually felt as a hard, firm mass without a fever. Gentle massage, hot packs, and frequent feeding from both breasts are the best relief.

BREAST INFECTION (MASTITIS):Causes a red, warm and painful mass associated with a temperature over 100.4 degrees F. Should this develop, contact our office immediately. The usual treatment is antibiotics and hot packs. Avoid massage, as this can cause the infection to spread. Continue to breastfeed to avoid an abscess.

WEANING:Can be accomplished at any time. Planning ahead is helpful, beginning with a gradual decrease in the length and number of feedings. Avoid hot showers or any stimulation to the breast area that would encourage milk production. Continue to wear a good support bra, apply ice and bind the breasts tightly. Medication is not recommended to stop breast milk. It is recommended to use ibuprofren to decrease discomfort.

UTERINE CRAMPS:Uterine cramping is normal, especially while breastfeeding. This cramping is how the uterus stops bleeding and returns to its pre-pregnant size. The uterus takes 4-8 weeks to return to its pre-pregnant size.

VAGINAL BLEEDING AND DISCHARGE:Postpartum vaginal discharge, also called lochia, usually lasts about 2 to 6 weeks, yet even up to 8 weeks is normal. The color will change from bright red to brownish to tan and will decrease each week. It is normal to occasionally have a heavier gush of blood, especially after breastfeeding or with increased activity. Your bleeding should then return to the amount of flow you had prior to the gush of blood. Normal bleeding is less than a pad per half hour. If you are soaking a large maxi pad (soaked front to back, side to side, through and through) more than every ½ hour, more than once, please call your doctor. Do not use tampons until after your six week postpartum visit. Your period will resume in approximately 6-8 weeks if you are not breastfeeding. If you are breastfeeding, it is common not to have your period.

EPISIOTOMY CARE:A “Sitz Bath” is simply sitting in a tub of warm water for 15 minutes, 2-3 times per day. This will help relieve the discomfort. Tucks pads, Witch Hazel and Lanacaine, may be applied to the external vaginal area as needed. You may also use oral pain medications as described above. Stitches will dissolve in 1-3 weeks. You will be more comfortable if you are not constipated; please follow directions above to prevent/treat constipation.

HEMORRHOIDS:Sitz baths, as described above, can help alleviate hemorrhoid pain as well. You can also use topical agents such as Motherlove’s Rhoid Balm, Tuck pads, Witch Hazel pads, or Preparation H or Preparation HC. Actively prevent constipation.

ACTIVITY:Rest! Do not do heavy housework or strenuous exercise for two weeks. Walking is the exercise of choice during this time period. If you had a vaginal delivery, and are not taking narcotics, then it is fine to drive. If you had a c-section, do not drive for 1-2 weeks (or longer if you are still taking narcotics). If you had a c-section, then you should avoid heavy lifting for 6 weeks. You may carry your baby in a car seat, but nothing heavier. It is fine to go up and down stairs.

PELVIC REST:Avoid tampons until your postpartum visit. Do not douche. Generally, we recommend abstaining from intercourse until you are 6 weeks postpartum. However, if you are between 4 and 6 weeks postpartum, you have completely stopped bleeding and your episiotomy is well-healed and non-tender, then it is okay to have protected intercourse.

Reasons to call your provider before your scheduled postpartum visit:

Fever greater than 100.4

Cesarean incision that is red, draining or increasingly painful.

Signs of a breast infection; red and painful area on your breast, especially if

associated with fevers greater than 101 and/or flu-like symptoms

Foul-smelling vaginal discharge

Excessive vaginal bleeding (see above section on vaginal bleeding)

Swollen, red, painful area on your leg

Chest pain

Persistently painful urination or inability to urinate

Worsening vaginal or rectal pain

Crying and periods of sadness lasting longer than two weeks

If you have questions about your infant, please call your Pediatrician

When to Call for Labor

Your contractions should be five minutes apart or less (from the start of one to the start of the next one), about one minute long, for at least one hour. An easy pneumonic for when to call for labor is 5-1-1. Your contractions should be strong enough that you must stop what you are doing, including talking, and breathe through them. If you feel you could sleep through your contractions, you are unlikely to be in labor. If you have a history of rapid labor, please discuss this with your provider at your prenatal visit. When your membranes rupture (water breaks), the fluid will gush or leak. You will not be able to control it. Usually the fluid will run down your leg if you do not have a pad on. Even if you are not having contractions, you should still call the office if your water breaks. If you are unsure if your water has broken, please call us. If the baby is not moving as much as he/she normally moves:

Eat or drink something

Lay down on your side

Count the baby’s movement. If you do not count 10 movements within one hour, call the office.

If you are bleeding abnormally:

Call the office if you are bleeding as heavily as a period.

It is not uncommon to spot or bleed after an exam or at the start of labor.

It is not uncommon to see a large strand of bloody mucous, also known as your mucous plug. You do not need to worry about the timing of your mucous plug and can wait to call until your labor signs meet the above criteria.

Call the office 24 hours a day, 7 days a week when you go into labor: 303-738-1100. If it is after-hours or during the weekend, your call will be forwarded to our Provider on call.